The value of nutritional assessment methods in surgical patients living in Saudi Arabia

Several methods have been propsed to assess nutritional status of patients in relation to post-operative complications including instant nutritional assessment (INA) and prognostic nutritional index (PNI). Weight loss (WL) has also been related to post-operative morbidity. A prospective study was conducted to evaluate the prognostic ability of INA, PNI and WL in 300 patients affected by major and semi-major surgeries. Post-operative sepsis occurred in 28 (9.3%) patients. Of the 300 patients studied, 91 (30.2%) had WL 10%; 12 patients were septic. Of the 28 septic patients indentified, 24 (85.7%) were within the high-risk group as identified by PNI characterisation. When both serum albumin and total lymphocyte count were abnormal, sepsis rate was 100%. All methods had a Youden index greater than one. Therefore, WL should be the first parameter assessed, and if WL is > 10%, then INA can be used to assess the patient further.     

Prognostic role of preoperative nutritional and immunological assessment in the surgical patient

The utilization of delayed hypersensitivity response (DHR) for the identification of high-risk patients with regard to postoperative septic complications is still discussed. The aim of this study was to clarify how much DHR may improve the prognostic capacity of nutritional assessment (NA). Nutritional and immunological evaluations were performed at admission on 405 patients undergoing elective general surgical procedures. Subjects with serum albumin less than or equal to 3.0 g/dl or total iron-binding capacity less than or equal to 220 micrograms/dl or weight loss greater than or equal to 10% with respect to usual body weight were classified as malnourished. DHR was assessed by performing skin tests with four recall antigens: PPD, candida, trichophyton, sk-sd. The incidence of postoperative complications resulted higher among the 187 malnourished patients (31.0%) than in the 218 well-nourished ones (14.2%) (p less than 0.001), and among the 213 anergic patients (29.6%) than in the 192 normal responders (13.5%) (p less than 0.001). To determine how much skin tests may improve the prognostic ability of NA, the relationship between DHR and postoperative complications was also studied in the malnourished and in the well-nourished patients, separately. In the malnourished group, the patients with an impairment of DHR had a higher incidence of postoperative infections than normal responders (p less than 0.05). In the well-nourished group, no significant differences were found between anergic patients and normal responders. In our study, DHR slightly improved the prognostic capacity of NA. Therefore, the first approach to identify the high-risk patients seems to be the unexpensive, quick and available determination of nutritional status.     

The adjunctive value of routine biochemistry in nutritional assessment of hospitalized patients

Nutritional screening and assessment of patients are not part of the routine procedures at hospital admission, although a large percentage of patients is malnourished. Similarly, nutritional status of patients and dietary intake is usually not monitored during hospitalization. In contrast a great number of laboratory investigations for screening purposes accompanies most, if not all, hospital admissions. Several of those routine markers carry important nutritional information and could convey several aspects of patients' nutritional requirements. This review proposes that laboratories in particular could provide a service for the nutritional interpretation of available routine data which would help clinicians to focus on nutrition related problems. The nutritional meaning of basic physical characteristics (age, sex, height, and weight), urinary excretion of ketone bodies, urea and creatinine, and serum concentrations of urea, phosphate, iron and albumin are discussed in detail and the assessment of protein malnutrition, metabolism, and requirements is emphasized. Finally, a proposed sample layout for the nutritional interpretation of routinely available biochemical and basic physical data is presented.     

Prognostic ability of nutritional assessment methods in surgical cancer patients

To identify patients at high-risk for post-operative infections, several methods have been proposed, including prognostic nutritional index (PNI), instant nutritional assessment (INA) and nutritional assessment (NA). Weight loss (WL) has also been related to post-operative morbidity. We have evaluated the prognostic ability of PNI, INA, NA and WL in a prospective study carried out in 94 patients affected by gastro-intestinal malignancy, who underwent major surgery. Post-operative infections occurred in 26 (27.7%) patients. PNI, INA and NA identified classes of patients with a progressive risk of septic complications. To determine the prognostic ability of PNI, INA, NA and WL, sensitivity, specificity, Youden index and predictive values were evaluated. All methods had a Youden index greater than one, with a positive predictive value ranging from 0.33 to 0.36. Since all the methods studied showed a similar predictive ability, it seems reasonable to identify the high-risk surgical patient by using weight loss in association with those nutritional parameters derived from routine hospital laboratory tests.     

主观综合性营养评价法在住院病人营养状况及预后评价中的作用

主观综合性营养评价法(SGA)虽在临床应用广泛,但对其用途及评价结果的临床意义,各家报道差异甚大.有些研究将其视为筛选营养风险的工具;有些将其视为预测病人预后的工具,甚至将其视为评价其他营养评价方法或指标的参照值.不同营养状况评价指标所反映出的营养状况改变的侧重点不同.故临床应针对不同病人采用不同的评价方法或指标,以客观和有所侧重地评价病人的营养状况,为实施营养干预提供依据.     

不同营养评估工具在重症肾脏病中的应用价值分析

重症肾脏病是20世纪90年代提出的新兴概念,重症肾脏病病人营养不良发生率高,与死亡风险升高显著相关,因此早期评估重症肾脏病病人的营养状态至关重要.目前国内外开发了多种营养评估工具,而鲜有研究将其应用于重症肾脏病领域.本文通过分析重症肾脏病病人营养不良风险的相关因素,比较了常见营养评估工具在重症肾脏病领域应用的优势和局限性,并为临床选择合适的营养评估工具给出建议.     

不同营养评估工具在重症肾脏病中的应用价值分析

重症肾脏病是20世纪90年代提出的新兴概念,重症肾脏病病人营养不良发生率高,与死亡风险升高显著相关,因此早期评估重症肾脏病病人的营养状态至关重要.目前国内外开发了多种营养评估工具,而鲜有研究将其应用于重症肾脏病领域.本文通过分析重症肾脏病病人营养不良风险的相关因素,比较了常见营养评估工具在重症肾脏病领域应用的优势和局限性,并为临床选择合适的营养评估工具给出建议.     

小儿外科住院病人营养评定

通过对150例小儿外科住院病人进行营养评定。发现21％～55％患者有不同程度营养不良,轻中度为主。少年儿童发病率高于婴幼儿。统计学分析表明:营养评定指标一致性差,独立性强,营养评定宜多指标综合分析。建议在临床小儿病人营养评定采用全面人体测量结合白蛋白和转铁蛋白测定。     

The assessment of nutritional status in children

McLaren and Read's widely used nomogram and chart devised for rapid computation of nutritional status in children has been critically evaluated. The nutritional assessment assigned by nomogram and chart was compared to that assigned by direct calculation from standard growth charts. We noted considerable discrepancy between the two methods. When a child's height was above the 50th percentile, the nomogram and chart always underestimated the severity of malnutrition, while severity of malnutrition was overestimated by nomogram and chart when height was below the 50th percentile. Further analysis of both the nomogram and chart revealed they were based on ideal weight for height at the 50th percentile, corrected for age. Thus, the nomogram and chart erroneously assess nutritional status if height is divergent from the 50th percentile. The ideal weight to height ratio (gm/cm) is not only affected by age, but also affected by percentile ranking; the ratio rises with increasing percentile ranking. This variable of percentile ranking for height is not accounted for adequately by either the nomogram or chart. Therefore, we cannot recommend either the nomogram or chart for rapid computation of ideal weight or nutritional status.     

纤维连接蛋白和前清蛋白在营养支持效果评价中的作用

目的:评价纤维连接蛋白和前清蛋白作为腹部外科术后营养支持效果指标的意义.方法:测定腹部外科术后病人行营养支持前后的血清清蛋白、转铁蛋白、前清蛋白和纤维连接蛋白水平,并测定营养支持期间每天氮平衡.结果:与营养支持前相比,血清转铁蛋白、前清蛋白和纤维连接蛋白水平在营养支持后明显升高(P＜0.05),前清蛋白与纤维连接蛋白水平的升高呈正相关.结论:血清纤维连接蛋白和前清蛋白对评价术后营养支持效果有一定的参考价值.     

Pre-operative nutritional assessment in the elderly

Nutritional depletion has been frequently documented in adult surgical patients admitted to hospital with nutritional status being known to deteriorate over the course of the hospital stay. In the elderly in particular, undernutrition has serious implications for health and for recovery from illness or surgery. This, in turn, has cost implications for the health service and the efficient distribution of health care. Because nutritional depletion is often insidious, nutritional problems frequently go unrecognised and untreated. Nutritional screening and assessment of nutritional status should therefore form an essential part of the health care of any elderly patient who requires surgical intervention. This paper aims to review the screening and assessment techniques currently available and their applicability to the elderly surgical patient.     

Preliminary assessment of nutritional value of traditional leafy vegetables in KwaZulu-Natal,South Africa

In this report, we present preliminary nutritional data for traditional leafy vegetables collected in Kwa Zulu-Natal, South Africa, including their content of mineral elements (Ca, P, Na, Zn, Mg, Mn and Fe) and antioxidant levels. Twenty vegetables were studied: Amaranthus dubius, Amaranthus hybridus, Amaranthus spinosus, Asystasia gangetica, Bidens pilosa, Centella asiatica, Ceratotheca triloba, Chenopodium album, Cleome monophylla, Cucumis metuliferus, Emex australis, Galinsoga parviflora, Justicia flava, Momordica balsamina, Oxygonum sinuatum, Physalis viscosa, Portulaca oleracea, Senna occidentalis, Solanum nodiflorum and Wahlenbergia undulata. The results of this study provide evidence that these local traditional vegetables, which do not require formal cultivation, could be important contributors to improving the nutritional content of rural and urban people. From this study, it was determined that twelve leafy vegetables, namely A. dubius, A. gangetica, A. hybridus, A. spinosus, C. metuliferus, C. monophylla, C. triloba, G. parviflora, J. flava, M. balsamina, P. viscosa and W. undulata provide mineral concentrations exceeding 1% of plant dry weight and are much higher than typical mineral concentrations in conventional edible leafy vegetables; they are thus recommended for future commercial cultivation. High levels of antioxidant activity (96%) were noticed in J. flava and P. oleraceae.     

Effects of a surgical pre-operative assessment clinic on patient care

Surgery makes many demands of both hospitals and patients. For the hospital, there are many procedural aspects: admission, health assessment, and patient education; the actual operation; and the post-surgical recovery period, a time when patients are susceptible to complications and nosocomial infections. For the patient, surgery means physical pain and emotional anxiety. A pre-operative assessment clinic (POAC), however, can assist both hospital and patients by streamlining their admission, assessment, and education, by decreasing the time they spend in the hospital recovering from surgery, and by easing their anxiety. In this article, the authors describe a study of a POAC at a Canadian hospital.